Wild Rose Physio PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

WILD ROSE PHYSIO PLLC

Practice address

325 W Palouse River Dr
Moscow, ID 83843-8956

Phone

(208) 689-6044

Fax

(208) 242-4018

NPI assigned

Jun 4, 2024

Last updated

Jun 4, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lauren Jentges, PT, DPTNPI 1043643885

Title

Owner

Phone

(206) 948-7475

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lauren B Jentges, DPT

  • Physical Therapist
  • Bothell, WA
  • NPI 1043643885
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1154162113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51",
            "city": "TROY",
            "state": "ID",
            "postal_code": "838710051",
            "telephone_number": "206-948-7475",
            "fax_number": "208-242-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W PALOUSE RIVER DR",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838438956",
            "telephone_number": "208-689-6044",
            "fax_number": "208-242-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD ROSE PHYSIO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "JENTGES",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-948-7475",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Werner, PHD
• Victoria White Eagle Hahn, LCSW
• Jordahn Saige White
• Alan J. Whitlock, PH.D.
• Lorna Wigen, LMSW
• Sara Elizabeth Wildman, RDN, RD
• Dayna K. Willbanks, OTR/L
• Madison Willhide
• Jacqueline M Williams, MS, LAT, ATC
• Wilson Polito PLLC (Alpine Vision Center)

• Physical Therapy Clinic/Center in Moscow, ID
• Providers in Moscow, ID by specialty
• Physical Therapy Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.